On August 9, —-, the Discipline Committee found that Dr. ———- committed an act of professional misconduct in that he engaged in conduct or an act of omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonable be regarded by members as disgraceful, dishonourable or unprofessional.

With respect to Patient A, in the summer of 200-, Dr. ———- inappropriately commented “nice Brazilian tan lines” to Patient A during a medically-indicated breast examination. Furthermore, prior to conducting a medically-indicated pelvic examination, Dr. ———- did not: 1) explain why he viewed this examination as appropriate in the circumstances; 2) explain the steps involved in the examination; or 3) ascertain whether the patient was comfortable with the steps involved in the examination that he about to undertake.

With respect to Patient B, in approximately 199-, Dr. ———- did not take care to maintain spatial boundaries while he performed a medically-indicated breast examination upon her. This resulted in Patient B feeling Dr. ———-‘s pelvic area against her arm while he conducted the breast examination. Dr. ———- also made inappropriate comments to Patient B regarding her sexual relationship with her husband.

With respect to Patient C, Dr . ———- made inappropriate comments to this patient regarding her sexual relationship with her husband during a medical appointment in 199-.

Reasons for Penalty

The Committee noted the fundamental importance of proper and respectful boundaries in dealing with subjects of an intimate nature of performing intimate examinations. It is of particular importance that patients be informed, that spatial boundaries are respected, and that physicians in refrain from inappropriate comments. Failing to act appropriately undermines public trust in the profession and may cause patients to feel embarrassed or offended.

The Committee viewed the conduct in this matter as highly unprofessional, with Dr. ———-exhibiting poor judgment in his comments and failure to maintain spatial boundaries during the examination of female patients who were exposed and vulnerable.

In considering he proposed penalty, the Committee also had regard for a number of mitigating factors, which included hat:

• Dr. ———- voluntarily completed the College’s course in Understanding Boundaries: Managing the Risks Inherent in the Doctor-Patient Relationship
• Dr. ———- had no prior discipline findings within the College
• Patients have been saved the difficult and embarrassing prospect of having to testify in a contested hearing; and
• Letters of reference were submitted from a number of close working colleagues of Dr. ———- who were fully aware of the issues of this case and their impact on Dr. ———-‘s practice

Lastly, the Committee understand its legal obligation where there has been a joint submission to accept the joint submission unless to do so would be contrary to the public interest and bring the administration of justice into disrepute.

Order

The Discipline Committee ordered and directed that:
1. Dr. ———- appear before the panel to be reprimanded.
2. The Registrar suspend Dr. ———–‘s certificate of registration for period of two months
3. The Registrar impose the following terms, conditions and limitations on Dr. ———-‘s certificate of registration:
i. Dr. ———- shall conduct all breast, pelvic and/or rectal examinations of any female patients in the presence of another female regulated health professional,
ii. Dr. ———- shall post a sign in his waiting room and in each of his examination rooms, in clearly visible locations that states: “Under no circumstances will Dr. ———- perform
a breast, pelvic, or rectal examination except in the presence of a female regulated health professional.”
4. Dr. ———- pay to the College costs in the amount of $–.

Discussion Questions

What is your opinion of such records being made public? What kinds of responses would you anticipate this piece to elicit from patients and other clinicians?

What does this piece tell us about maintaining boundaries in the physician-patient relationship? Does it bring you to rethink this boundary in any way?